1. CASE STUDY
Patient is 54 year old female
GCS 6/15
Pupils 10 mm
Caorse nystagmus
Increase tone
HR 135/min, regular
Heart and lungs ex,: normal
Bp 105/60 mmHg
Brisk reflexes

2. EXAMINATION OF THE
ABDOMEN:
suprapubic mass, suggested full bladDer
the patient was catheterized--- drained 2L of urine
the patient had
Generalized seizure 30 s
erythema followed( ventricular tachycardia)

3. LAB RESULTS AS FOLLOWS
Hb 14g/dL
WCC 12000/dL
Platelets 221000/dL
Blood glucose 6 mmol/L
Plasma osmolality 333 mOsm/L
sodium 144 mmol/L
Potassium 4.0 mmol/L
Urea 13 mmol/L
Urine osmolality 120 mOsm/L

4. LAB RESULTS
Chest X ray = Normal
Skull X ray= Normal
Brain CT scan= Normal
Lumbar Puncture
Glucose 3 mmol/L
Pressure 100 cm H20
Protein .35 g/L

5. DIAGNOSIS
• Combination of convulsion and ventricular tachycardia suggests Tricyclic antidepressant overdose.
• This hypothesis is supported these additional signs observed:
Anticholinergic side effects
sinus tachycardia
Dilated pupils
Retention of Urine
Low urine osmolality

6.  Calculated plasma osmolality= 315
 Measure plasma osmolality =330
 Calculated osmolality<Measured
this is an indication that the patient has ingested somethings that is measurable.
 very likely its
either Alcohol or Lithium which has resulted low urine osmolality.

7. CORRECTION/TREATMENT
 The possible treatment for the patient are
 Protect airways
 IV fluids
 Correct acidosis
 Gastric lavage and charcoal
 Supply of oxygen to the tissue and other oxygen deprived organs.

8. BY ISMAIL SALAD